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Should I take paracetamol for back pain or see a chiropractor

Written By, On March 12, 2014

Painkiller paracetamol’s ‘link to liver failure’

BRITAIN’S most popular painkiller is at the centre of a major health scare over fears it can cause liver failure and death.

Health regulators are to limit the amount of paracetamol in prescription medicines because of soaring cases of liver damage.

Paracetamol – also known as acetaminophen – is highly toxic to the liver if taken in excessive amounts and even more dangerous at the larger doses found in prescription combination drugs. But if taken with a second over-the-counter drug that already has high levels of paracetamol, it can kill. Paracetamol is often found in cold and flu medicines without realizing people are overdosing on a regular basis.

Now the US regulator, the Food and Drug Administration, has announced it will cap the amount of paracetamol in drugs at 325mg per capsule instead of the current 500mg. Some prescription medicines in America contain as much as 750mg of paracetamol.

In Britain, prescription-only and over-the-counter paracetamol tablets are limited to 500mg. People are warned not to take more than two 500mg pills in four hours and no more than eight in 24 hours. Taking more could lead to acute liver failure.

You only need to take one or two extra tablets to cause liver damage. In some cases just 10g of the drug – or 20 tablets – has been linked to overdose and liver damage. Sudden liver failure, which can be caused by the drug, can lead to the brain rapidly swelling often giving doctors little chance to save people. Just days ago it emerged that ibuprofen painkillers cause an increased risk of strokes in heart disease sufferers.

In 2009 1,198 deaths were put down to adverse drug reactions –up by almost 100 on the previous five years. Paracetamol was linked to 33 deaths in 2009.

One in 20 adults regularly take at least six painkillers when ill. ­Britons each consume an average of 373 painkillers every year.

Sandra Kweder, from FDA’s Center for Drug Evaluation and Research, warned: “Patients taking these prescription products often do not know they are taking paracetamol  at all. They don’t realise that they’re overdosing.”

The change in dose will be phased in over three years.

A spokeswoman for UK regulator, the Medicines and Healthcare Products Regulatory Agency, said:  “In response to concerns about the risks associated with overdose, we have put in place a number of risk minimisation measures in the UK aimed at reducing the risk of liver damage following deliberate or accidental overdose from paracetamol.”


Healthy Sharon Loughran, 45, died after accidentally overdosing on paracetamol. At her inquest in 2009, South and East Cumbria coroner Ian Smith warned of the dangers of overusing the drug. Mrs Loughran suffered liver failure after regularly taking two or three pills. The sudden liver failure led to her brain swelling and gave doctors no chance to save her. Her husband Craig told the inquest how she was generally fit and healthy, but suffered frequent headaches..

A forensic expert reported that going beyond regular doses would cause liver failure.

  • More than half of prescriptions given to children were wrong, study found

Parents often give their children Calpol or similar medicines containing paracetamol at home before going to a GP who prescribes another painkiller.  One in four babies is being given too much paracetamol by ‘over-confident’ GPs and parents, a major study claims.

Experts warn that in these cases, too much of the painkiller can cause liver damage.

The study found that parents often give their children Calpol or similar medicines containing paracetamol at home before going to the GP who then prescribes yet another painkiller.

It said 22 per cent of babies aged between one and three months had been given an overdose of paracetamol over a 12-month period, with another 5 per cent who were likely to have been given an overdose.

Official guidelines state that babies aged between three and 12 months should be given no more than 240mg of paracetamol a day – the equivalent of just two teaspoons of Calpol.

But the researchers warn that  many parents will give babies half a  teaspoon every few hours on top of another painkilling medicine prescribed by their GP, which is far too much.

Astonishingly, the research also found that 15 per cent of medicines handed out had  not come with any instructions saying how much should  be given.

Dr James McLay, one of the study’s authors, said parents and GPs were ‘over-confident’ in prescribing paracetamol.

Dr McLay, from the department of medicine at the University of Aberdeen, said the study was the first to describe the patterns of paracetamol prescribing by primary care physicians in the community. He added that it was worrying to discover that just over half of the prescriptions failed to comply with basic recommendations on dosage amounts from the British National Formulary for Children..

There have been some reports of children prescribed too much paracetamol suffering liver damage.

In a study, a team led by Dr Kenneth Simpson analysed data from 663 patients who had been admitted to the Edinburgh Royal Infirmary between 1992 and 2008 with liver damage caused by paracetamol.

They found 161 people with an average age of 40 had taken a staggered overdose, usually to relieve stomach and back pain, headache or toothache.  Back pain is the most common pain full condition experts are concerned how often back pain patients self-prescribe painkillers without knowing the dangers. Treatment such as chiropractic should be used more often than just self-prescribing painkillers.

Two out of five seen in the study died from liver failure – a higher fatality rate than recorded for deliberate overdosing, says a report in the British Journal of Clinical Pharmacology.

Dr Simpson, of Edinburgh University and the Scottish Liver Transplantation Unit, said staggered overdoses can occur when people have pain and repeatedly take a little more paracetamol than they should.

He said: ‘They haven’t taken the sort of one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up and the effect can be fatal.

‘They are often taking paracetamol for pain and they don’t keep track of how much they’ve consumed over a few days.‘But on admission, these staggered overdose patients were more likely to have liver and brain problems, require kidney dialysis or help with breathing and were at greater risk of dying than people who had taken single overdoses.’

Hospital doctors may find low levels of paracetamol in the blood of people suffering from staggered overdoses even though they are at high risk of liver failure and death. Dr Simpson said some people reacted worse to a lower dose than others, with high alcohol consumption exacerbating the problem – and it was not possible to identify them in advance.

He said 10g was the lowest amount in the study leading to death while 24g over 24 hours was a recognised fatal dose.

‘The safest thing to do is monitor how much you’re  taking and do not exceed  eight 500mg tablets in a day,’ he said.

Normal quantities of the drug are broken down harmlessly by the body but excessive amounts can accumulate in the liver, leading to irreversible damage.
Paracetamol is one of the most common painkillers we use — every day thousands of packs are sold in supermarkets and chemists, and it’s our favourite remedy for dealing with a headache.

Desiree Phillips a 20-year-old single mum died last August of acute liver failure caused by paracetamol poisoning.

In pain after an operation to remove non-cancerous lumps in her breasts nine days earlier, Desiree was recovering at home, taking ‘a few more’ tablets than the recommended maximum daily dose of eight 500mg tablets, when she was found unconscious and rushed back to hospital.

She underwent a liver transplant but it was not successful.

Paracetamol had built up in her body without anyone noticing — the drug produces a by-product known as NAPQI, which attacks the liver. As it gradually accumulates, it can result in a ‘staggered’ overdose.

Last November, a medical journal published research showing that just a few extra paracetamol daily can be fatal and that a staggered overdose is much more likely to be fatal than a deliberate one

The Government is rightly concerned about the effect of binge drinking on our livers — hence David Cameron’s campaign to introduce minimum pricing of alcohol —

 but overdosing on paracetamol, not booze, is the most common cause of acute liver failure in the UK.

Yet still the National Health Service say there’s no cause for concern. Millions of us use the drug with no side-effects. But when you are in chronic pain — the elderly with aching joints or a workaholic suffering from repetitive headaches — more and more of us think: ‘To hell with the stated daily dose, I’ll just take a couple more.’

I’ve written before about the dangers of addiction to over-the-counter drugs such as Nurofen Plus, but paracetamol .There are no checks when you buy a packet of paracetamol, unlike codeine. That needs to end.

All painkillers should be carefully controlled — because we have become a nation of massive pill-poppers. An ageing population is being handed huge amounts of prescription drugs to deal with arthritis and spinal degeneration. These drugs are often supplemented with over-the-counter preparations which no one is monitoring.

The number of people addicted to non-prescription painkillers is soaring and still the Government doesn’t intervene. Now, there’s a new danger — 39,000 packs of co-codamol, containing paracetamol and codeine, which are  three times stronger than the dose stated on the packet, have gone on sale by mistake.

A spokesman for the UK medicines regulator said: ‘If you feel you have taken the wrong strength tablet, and in the unlikely event you feel unwell, speak to your GP.’ That sounds pretty complacent to me.


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